(This form is to be completed and returned only if an order is to be canceled)

To Carl Hansen & Søn, Hylkedamvej 75, 5591 Gelsted, Denmark
Phone: +45  6612 1404
E-mail: webshop@carlhansen.dk

I/we hereby announce that I/we wish to exercise the right to cancel my/our purchase agreement for the delivery of the following goods/of the following services.

The right of cancellation

Order date:

Received on:

Item/Product(s):

Order number:

Name:

Address:

Date:

Signature:
(Only if the contents of the form are submitted in writing)